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Can employee screening protect vulnerable patients?

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A new vetting and barring employment scheme is planned for next year. Richard Staines investigates how it will affect nurses

In a major shake-up of public protection regulations, a new vetting and barring system for people who work with children and vulnerable adults will be introduced next year, which all nurses will eventually have to join in order to continue practising.

The proposed scheme will be administered by the new Independent Safeguarding Authority (ISA), which was set up in January. It will supersede arrangements currently in place in the social care sector, and will for the first time embed a wholesale vetting and barring protocol at the heart of the NHS.

The issue of patient vulnerability was brought into sharp focus earlier this month by the case of David Britten, a senior NHS nurse who sexually abused more than 20 patients with eating disorders over a 20-year period.

Only when separate, unrelated allegations caused Central and North West London Mental Health NHS Trust to dismiss Mr Britten for gross misconduct did his abuse of vulnerable patients come to light.

How Mr Britten remained able to carry out this level of abuse raised further questions about the effectiveness of current regulatory systems.

A report into the case by NHS London criticised the NMC for failing to issue an immediate interim suspension order on Mr Britten, leaving him free to practise for as long as two years after his dismissal (NT News, 22 July, p3).

Aside from criticising the NMC, the report is confident that the new regulatory framework should help prevent future cases.

So what exactly is ISA and what will the changes mean for the current system?

The ISA scheme was created following a recommendation made by the Bichard Inquiry into the murders of Jessica Chapman and Holly Wells by Ian Huntley in 2002, which called for a single agency to vet all individuals who want to work or volunteer with vulnerable people.

Unlike its predecessors, the ISA scheme will operate a ‘positive’ register rather than a ‘black list’ – meaning that only people who are on it will be able to practise. Those who are subsequently found to be unfit to practise will have their name removed, in the same way as the NMC register.

In total, ISA estimates that around 11 million people will have to sign up to the new scheme across England, Wales and Northern Ireland.

Central to its comprehensive vetting powers, the system, scheduled to come into effect in autumn next year, will also have a single list of all those who are barred from working with children and another of those barred from working with vulnerable adults.

These will be known as the Barred Lists and will unite and replace the current Protection of Vulnerable Adults (PoVA) list, List 99 and the Protection of Children Act (PoCA) list.

A separate but aligned scheme is being set up in Scotland under the Protection of Vulnerable Groups (Scotland) Act 2007, which means that anyone barred from working with children and vulnerable adults in Scotland will also be banned across the UK.

So what will the ISA scheme mean for nurses on the frontline?

The system will be extended across the entire health service and is planned to ‘go live’ on 12 October 2009. The first entrants on its register will be those staff who are beginning new jobs.

From 2010, the scheme will be extended to existing employees, including those who have already undergone CRB checks.

Those signing up to the register will be required to pay a one-off fee of £64, which is transferable and means they will not have to pay again if they change jobs.

This fee has two components. The first £28 will cover the cost of the ISA’s administration, volunteers registering with the scheme – as they register for free – and the cost of continuously updating the scheme. The remaining £36 will cover the CRB’s administration costs.

In practice this will mean that anyone starting a new job in 2009 will be required to pay, and, from the year after that, anyone wanting to continue in their current job.

Nursing unions have welcomed the idea that the ISA scheme will mean improved safeguarding of vulnerable people, with more professions and specific job roles closed to those who are barred under the new lists. But they have also noted some caveats and concerns.

They argue that nurses should not have to bear the burden of this new fee. The cost of vetting using Criminal Record Bureau (CRB) checks is currently paid by their employer as part of the recruitment process. The new proposals transfer this cost on to the individual.

Gail Adams, Unison’s head of nursing, said: ‘They will be paying NMC registration and £64 to the ISA to be on their register.’

Unison has also warned in a briefing document to MPs that the new fees are likely to have an impact on recruitment and retention in the nursing and public sector as a whole. They may deter people from taking public sector jobs, it warned.

‘[The scheme] could influence whether or not an individual chooses to work in public services, if working in schools and hospitals costs more than working in other organisations,’ the paper states.

There are also concerns that the system will add yet another layer of bureaucracy to the NHS.
‘We need to make sure that we do not over-regulate. We can’t introduce a mechanism which creates unnecessary obstacles,’ said Howard Catton, RCN head of policy.

Additionally, it remains unclear how ISA will share information with the NMC. The Department of Health said last week that the NMC will be able to make referrals to the new list. But details on how the organisations will share data on CRB checks and other sensitive information has not been revealed.

A final area of concern is that the system be fair, transparent and contain a mechanism allowing people to appeal.

The old PoVA system, for example, had to be changed following a judicial review brought by the RCN. Under the scheme, a nurse could be placed on the PoVA list and prevented from working on the back of allegations that did not constitute a major public risk – such as leaving a medicine cabinet open.

Following the review, nurses facing allegations not involving a serious risk to the public, were able to argue against them before any suspension occurred.

Mr Catton called for a similar safeguard of appeal to be included in the new system. ‘If people find themselves barred, what options are there for them to put their case? If somebody is barred by mistake there is a huge impact on their career and their reputation,’ he said.

Although there are clearly concerns surrounding the details and operating practicalities of the new ISA scheme, every nurse would agree that strong regulation is vital to the profession’s credibility.

As Home Office minister Meg Hillier said in April, ISA will set in place ‘one of the most robust employment checking systems in the world’.

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